<cfoutput>
	#dspDocumentHeader()#
	<h2>Individual Treatment Plan</h2>
	<cfif PARAMS.key NEQ 0>#dspFormButtons(key=PARAMS.key, action=PARAMS.controller)#</cfif>
	<fieldset>
		<legend class="title">Psychiatric Diagnosis, <span class="caption">COMAR 10.21.26.07 A(2)(b)(i)</span></legend>
		<dl>
			<cfloop list="I,II,III,IV,V" index="Label">
				<dt>Axis #Label#: <input type="text" /></dt>
				<cfif Label IS "V">
					<dt class="list">Current: <input type="text" /></dd>
					<dt class="list">Last Year: <input type="text" />
				</cfif>
			</cfloop>
		</dl>
		
		<h4 class="clear">Describe Factors and Symptoms that Precipitated this Consumer's Admission.</h4>
		
		<dl>
			<dt><input type="radio" /> Avoid Inpatient Hospitalization</dt>
			<dt><input type="radio" /> Shorten Onpatient Hospitalization</dt>
		</dl>
		
		<h4 class="clear">Describe the consumer's level of functioning prior to this particular crisis.</h4>
		
		<dl>
			<dt><input type="radio" /> Optimal Functioning: No symptoms. Able to adequately fulfill all areas of responsibility.</dt>
			<dt><input type="radio" /> Good Functioning: Minimal Symptoms. Minor impairment in one or more aspect of their life. Generally satisfied with life.</dt>
			<dt><input type="radio" /> Moderately Impaired: Unable to meet daily responsibility and has difficulty in multiple areas of life.</dt>
			<dt><input type="radio" /> Severe Impairment: Unable to function without significant monitoring or support. Experiencing severe mental health symptoms.</dt>
		</dl>
		
		<h4 class="clear">Briefly Explain Symptoms and Current Crisis, <span class="caption">COMAR 10.21.26.07A(2)(b)(ii)</span></h4>	
		<p><textarea></textarea></p>
	
		<h4 class="clear">Describe what the consumer desires from her/his stay at SJH:</h4>
		<p><textarea></textarea></p>
		<h4 class="clear">Consumer Name: <span style="font-weight: normal;"><!--- #Consumer.firstName# #Consumer.lastName# ---></span></h4>
	</fieldset>
	
	<fieldset>
		<legend class="title">Family/Collaterals/Community Supports</legend>
		<h4 class="clear"><em>Describe strengths and needs of active connections</em></h4>
		
		<table class="forms" width="80%" cellpadding="6">
			<cfset Labels = [
					'Family <div class="caption">COMAR 10.21.26.07A(2)(b)(iii)</div>','Extended Family<div class="caption">COMAR 10.21.26.07A(2)(b)(iii)</div>','Support Network<br />(Friends, Godparents)<div class="caption">COMAR 10.21.26.07 A(2)(b)(iii)</div>','Employment', 'Educational Services<div class="caption">COMAR 10.21.26.07 A(2)(c)(iv)</div>','Treatment Program<div class="caption">COMAR 10.21.26.07 A(2)(c)(iv)</div>', 'Individual Treatment Programs<div class="caption">COMAR 10.21.26.07 A(2)(c)(iv)</div>'
				]>
				
			<cfloop array="#Labels#" index="Label">
				<tr>
					<th width="200px" class="center" valign="middle" style="border-right: 0px none;">#Label#</th><td style="border-left: 0px none;"><textarea style="width:95%; height:150px;"></textarea></td>
				</tr>
			</cfloop>
		</table>
	</fieldset>
	
	<fieldset>	
		<legend class="title">Identifying Strengths & Needs, <span class="caption">COMAR 10.21.26.07 A(2)(b)(iii)</span><span style="font-size: .75em; font-style: italic; font-weight: normal;">(Check all that apply)</span></legend>		
		<cfset ColumnData = [
				{ 
					Label='Ability to Meet Basic Needs',
					Options=[
						'Performs all activities of daily living well, without prompting or assistance.', 
						'Performs most activities of daily living with some prompting.', 
						'Requires close supervision and or assistance to accomplish activities of daily living.', 
						'Unable to accomplish all activities of daily living or does so only with maximum supervision and assistance.'
					]	
				},
				{
					Label='Ability to manage money',
					Options=[
						'Allocates funds appropriately to meet personal priorities with out assistance or supervision.',
						'Experiences some difficulties in managing money and/or occasionally seeks assistance.',
						'Requires close supervision and or assistance to manage finances.',
						'Unable to allocate money to meet personal priorities.'
					]
				},
				{
					Label='Ability to make future plans',
					Options=[
						'Makes reasonable, future oriented plans.  Very goal directed.',
						'Plans for future in most instances.  Is relatively goal directed.',
						'Plans may not be realistic.  Tends not to be goal directed.',
						'Lives for the moment.  Cannot routinely plan for future.'
					]
				},
				{
					Label='Ability to engage in productive activities',
					Options=[
						'Focuses on productive activities.  Sees through to completion.  Currently employed.',
						'Employed prior to present crisis.  Has a record of stable employment.',
						'Has not been able to maintain employment for longer than a few months at a time. Has few or no vocational interests.',
						'Not employed and has no vocational interests.'
					]
				},
				{
					Label='Ability to engage in relationships',
					Options=[
						'Involved with friends and family.  Displays appropriate borders.',
						'Involved with friends or family.  Some difficulties.',
						'Some moderate difficulties in family or friendships.  Somewhat isolative.',
						'Essentially a loaner.  Virtually no involvement with others'
					]
				},			
				{
					Label='Ability to communicate needs clearly to those in authority',
					Options=[
						'Makes needs known.  Communicates clearly and directly.',
						'Makes most needs known.  Has some difficulty with clear communication.',
						'Significant difficulties in making own needs known.  Communication is often confusing.',
						'Does not communicate. Holds information in or fails to convey in an accurate manner.'
					]
				},
				{
					Label='Ability to recognize limitations of coping',
					Options=[
						'Knows limitations.  Has developed strategies to deal with stressful situations as an alternative.',
						'Occasionally becomes overwhelmed.  Usually develops alternative coping strategies.',
						'Often overwhelmed.  Limited means to deal with anxiety, anger and/or depression.',
						'Unable to effectively function.  Levels of anxiety, anger, and depression are debilitating.'
					]
				},
				{
					Label='Ability to absorb and utilize new information',
					Options=[
						'Thrives on learning.  Easily incorporates new information into personal repertoire.',
						'Able to learn and profit from new information.',
						'Resistant to new information.  May have difficulty incorporating new information.',
						'Unable to easily or effectively learn new information.  Tremendous difficulty adapting behavior.'
					]
				},
				{
					Label='Ability to manage feelings',
					Options=[
						'Discusses feelings and reactions to situations.  Develops positive strategies to deal with issues.',
						'Sometimes keeps feelings inside.  Most times develops strategy for dealing with issues.',
						'Often feelings drive actions and decisions. Can be re-directed and focused to look at situations in a more rational manner',
						'Very reactive to feelings.  Life choices are almost always driven by emotion.'
					]
				},
				{
					Label='Ability to accurately perceive current reality',
					Options=[
						'Sees life''s issues clearly and accurately',
						'Sometimes misinterprets situations.',
						'Some distortion in perception of reality.',
						'Significant and debilitating distortions in perception of reality.'
					]
				}
			]>
			
		<table width="95%">
			<col width="60%" />
			<col width="40%" />
			<cfloop array="#ColumnData#" index="Row">
				<tr>
					<td>
						<dl>
							<dt><strong>#Row.Label#</strong></dt>
							<cfloop array="#Row.Options#" index="Option">
								<dd class="hasCheckbox"><input type="checkbox" /> #Option#</dd>
							</cfloop>
						</dl>	
					</td>
					<td>
						<p><em>Comments:</em></p>
						<p>	<textarea style="width:100%;"></textarea></p>
					</td>
				</tr>
			</cfloop>
		</table>
		
		<cfset TreatmentGoals = [
					'Primary Goals for Treatment at Safe Journey',
					'Tasks/Objective Related to Goal<br />(Be specific and describe in behavioral terms, number each and link to goal)',
					'Frequency	',
					'Target Date',
					'Date Resolved'
				]>
				
		<h4 class="clear" style="margin-bottom: 0em;">Treatment Goal(s), <span class="caption">COMAR 10.21.26.07 A(2)(a)(i, iii), COMAR 10.21.26.07A(2)(b)(iv), COMAR 10.21.26.07A(2)(c)(ii), COMAR 10.21.26.07 A(2)(c)(i)</span></h4>
		<p style="margin-top: 0em;"><em>
			Goals should be formulated after careful review of:  Referral Form, Psychiatric Evaluation, Main Assessment, Previous ITP sections and Face to Face interactions w/ consumer.
			Goals need to include:  Current symptoms of Mental Illness, Any Somatic condition, Current Substance Abuse, Case Management needs(Housing, Entitlements, Mental Health 
			support services), Discharge Planning (Psychiatrist, Therapist, Day Program, Treatment Program)
		</em></p>
		
		<table class="forms">
			<cfloop from="1" to="2" index="intRow">
				<tr>
					<cfloop array="#TreatmentGoals#" index="GoalType">
						<cfif intRow EQ 1>
							<th valign="middle">#GoalType#</th>
						<cfelse>
							<td><input type="text" /></td>
						</cfif>
					</cfloop>
				</tr>
			</cfloop>
		</table>
	</fieldset>
	
	<fieldset>
		<legend class="title">Individual Treatment Plan: Treatment Team</legend>
	</fieldset>
	<cfif PARAMS.key NEQ 0>#dspFormButtons(key=PARAMS.key, action=PARAMS.controller)#</cfif>
</cfoutput>
